Porównanie zastosowania piersiowej blokady przykręgowej i znieczulenia ogólnego w chirurgii gruczołu piersiowego

Jerzy Paleczny¹, Elżbieta Łoniewska-Paleczny², Maciej Pysz³, Grzegorz Hura¹

Summary
Background. In a prospective, randomized study of cancer patients undergoing Patey mastectomy, we evaluated the effectiveness of thoracic paravertebral block (TPVB) with intravenous sedation, compared to general anaesthesia (GA). Material and methods. Fifty ASA physical status I and II patients undergoing a radical mastectomy were randomly assigned to two study groups of 25 patients each. In the TPVB group, 0.3 ml kg^-1 of 0.5% ropivacaine with 0.1 mg fentanyl and 75 mcg clonidine was injected into the paravertebral space at Th₃; 1 to 4 mg kg^-1 h^-1 propofol was continuously administered to maintain sedation at the level of 5-6 Ramsey points. In the other group, general anaesthesia was induced with propofol and maintained with fentanyl/nitrous oxide; rocuronium was used for relaxation. Results. There were no serious complications in either group. One block was unsuccessful. Mean arterial blood pressure during surgery and in the immediate postoperative period was lower in the TPVB group. GA patients experienced significantly more pain (p<0.001) than TPVB patients during the 72 hours after surgery. TPVB also resulted in less nausea and vomiting (p<0.0001) and gave greater patient satisfaction than GA. Conclusion. TPVB with sedation provided satisfactory conditions for radical mastectomy. Compared with GA, TPVB significantly improved the quality of postoperative analgesia, decreased the frequency of postoperative nausea and vomiting, and provided better patient comfort.

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